1. ^99mTc-albumin, HSA
   1. pH 2.5 - 5.0
   2. Lyophilized and in a nitrogen atmosphere
   3. One mL of sterile water is added to the reaction vial
   4. Maximum of 100 mCi of ^99mTc0₄^- is then added in > 3.0 mL solution
   5. Gently mixed, not to create foaming in the solution
   6. Let stand for 20 minutes before use
   7. Critical organ is urinary bladder wall
2. ^99mTcMAA, albumin aggregated
   1. pH 3.8 - 8.0
   2. Lyophilized and in a nitrogen atmosphere
   3. There is some variation between kits, however, usually before and after preparation the agent is stored in 2 - 8^oC
   4. Particle size should be
      1. 10 to 90: @ 90%
      2. Nothing greater than 150: at 10%
   5. After compounding, let stand for 15 minutes
   6. Particles per dose ranges between 100 - 600k
   7. Reduction in particles considered for
      1. Left to right shunt
      2. Pulmonary hypertension
      3. Pediatric patients
   8. Critical organ is the lung
3. ^99mTc-DISIDA, disofenin, Hepatolite
   1. pH 4 - 5
   2. Lyophilized and in a nitrogen atmosphere
   3. Mix with 4 - 5 mL of saline and ^99mTc0₄^- in 12 *- 100 mCi
   4. Let stand for 1 minute prior to use
   5. Critical organ large intestinal wall
4. ^99mTc-ECD, bicisate, Neurolite
   1. pH 2.7 (pH >3.0 reduces shelf-life)
   2. Lyophilized and in a nitrogen atmosphere
   3. Light will breakdown the compound
   4. Phosphate buffer is used to rise the pH to 7.6
   5. Compounding requires 3-steps
      1. Add 100 mCi of ^99mTc0₄^- in 2 mL to the phosphate buffer [use at least 50 mCi] (A)
      2. Add 3 mL of saline to the lyophilized ECD vial (B)
      3. Remove 1 mL from of B and add it to A (do this within 30 seconds)
      4. Incubate B for 30 minutes
      5. Critical organ urinary bladder wall
5. ^99mTcHMPAO, exametazime, Ceretec
   1. Contains 3 essential components required for labeling
      1. HMPAO is lyophilized and in a nitrogen atmosphere [A]
      2. 1% methyline blue [B]
      3. Phosphate buffer (A must be mixed with ) [stabilizer]
   2. Brain imaging
      1. Mix 0.5 mL of methyline blue with 4.5 mL of phosphate buffer (A)
      2. Add 10 - 54 mCi of ^99mTc0₄^- (B)
      3. Within 2 minutes add 2mL from A and place into B. This stabilizes HMPAO for up to 4 hours
      4. Inject with a 0.45: membrane filter to remove any particles from solution
      5. Note: The final solution will be blue in color
      6. Prior generator elution should have been completed within the 24 hours
      7. Current elution should be <30 minutes old for brain imaging and <2 hours old for labeled WBCs
   3. Leukocyte labeling - See this link
      1. Link discusses ¹¹¹In and ^99mTc labeled WBCs
      2. Critical organ is the spleen
   4. Radiochemical purity should be >80%
6. ^99mTc-GH, gluceptate
   1. pH 6.9 - 7.1
   2. Lyophilized and in a nitrogen atmosphere
   3. >300 mCi in 2 - 10 mL
   4. After compounding let the kit stand at room temperature for 15 minutes
   5. Critical organ is the renal cortex
7. ^99mTc-BROMIDA, BRIDA, mebrofenin, Choletec
   1. pH 4.2 - 5.7
   2. Lyophilized and in a nitrogen atmosphere
   3. Mix >100 mCi in 1 - 5 mL and let stand for 15 minutes
   4. Stable for up to 18 hours [Is there a problem here?]
   5. Critical organ upper large intestinal wall
8. ^99mTc-MDP, medronate
   1. Lyophilized and in a nitrogen atmosphere
   2. Several manufacturers have variation of the MDP compound which include:
      1. Type of reducing agent (SnF₂ or SnCl₂)
      2. Amount of activity and volume
      3. Temperature and storage before and after compounding
      4. Some kits contain antioxidants such as ascorbic acid or gentisic acid
   3. Critical organ urinary bladder wall
9. MAG3, mertiatide, TechneScan MAG3
   1. Lyophilized and in a argon atmosphere
   2. Light will breakdown the compound
   3. Vent the reaction vial and add 20 - 100 mCi in 4 to 10 mL
   4. Remove additional 2 mL of argon gas and replace it with room air. This remove excess stannous ion
   5. Within 5 minutes place reaction vial into boiling water for 10 minutes
      
      1. ^99mTc-tartrate is initially formed
      2. Betiatide is then hydrolyzed
      3. This allows the reduced ^99mTc to transfer to the mertiatide
   6. Let cool for 15 minutes before use
   7. pH is between 5 and 6
   8. Critical organ urinary bladder wall
10. ^99mTc-HDP, oxidronate, TechneScan HDP
    1. Lyophilized and in a nitrogen atmosphere
    2. Contains gentisic acid and SnCl₂
    3. Mix 0 - 300 mCi in a 3 to 6 mL for 30 seconds
    4. pH will be 4 - 5.5 and stable for 8 hours
    5. Critical organ bone surface
11. ^99mTc-DTPA, pentetate
    1. Lyophilized and in a nitrogen atmosphere
    2. Different manufacturers very in:
       1. Amount of volume and activity
       2. Amount and type of DTPA
       3. One kit contains Paraaminobenzoic acid (PABA) [increases shelf-life]
       4. Temperature storage before and after compounding
       5. Expiration time
    3. Following compound let stand for several minutes
    4. pH 3.8 to 7.5 and stable for 6 - 12 hours
    5. Critical organ bladder wall
12. ^99mTcPPi, pyrophosphate
    1. pH 4.0 - 7.5
    2. Lyophilized and in a nitrogen atmosphere
    3. Different manufacturers vary in:
       1. SnCl₂ with Mallinckrodt seems to contain the greatest amount [3.2 - 4.4 mg]
       2. Amount of volume and activity
       3. Storage
          1. Prior to use 2 - 8^oC to 30^oC
          2. After labeling 2 - 8^oC to 30^oC
    4. Critical organ bladder wall
13. Labeling RBCs
    1. In Vivo
       1. Add 3 mL of saline to the vial of PPi
       2. Calculate patient's dose at 10 - 20 :gm/kg of Stannous ion from the PPi vial
       3. Administer IV and let circulate for 20/30 minutes
       4. Inject IV ^99mTc0₄^- dose
    2. Modified In Vitro
       1. Acquire the following: 19 to 23 gauge butterfly with 12 inches of tubing, 3 - way stop cock, 10 mL syringe filled with 10U/mL of heparin, 10 mL syringe with ^99mTc0₄^-dose, and PPi dose in 3 mL syringe
       2. Setup IV with butterfly, 3-way stop cock and 10 mL of herparinized saline
       3. Keep the IV site open by flushing it with herparinized saline
       4. Inject PPi - dose is 15 :gm/kg of body weight
       5. Let circulate for 20 minutes
       6. Draw back 3 mL of whole body into ^99mTc0₄^- syringe
          1. Herparinized saline in tubing prevents blood from clotting
          2. Do not exceed 10U/mL of heparin, excessive heparin will reduce RBC tag
          3. Mix gently RBCs several times over a 10 minute
          4. Re-inject the labeled RBCs into the patient
    3. In Vitro Method - Ultratag RBC
       1. Contains reaction vial and 2 syringes system (syringe 1 and 2)
       2. From the above use 10 mL of herparinized saline, 3-way stop cock, and butterfly to establish IV site and to keep it open
       3. Draw 3 mL of whole body from IV site (heparin saline will prevent blood from clotting)
       4. Transfer blood into reaction vial
          1. Stannous ion in the vial enters the red cells and reacts with intracellular protein
          2. Add syringe 1 which contains hypochlorite that oxidizes the extracellular tin
          3. Add syringe 2 which contains citric acid monohydrate. This removes the tin to enhances labeling
          4. MIx vial every 5 minutes for 20 and re-inject
14. ^99mTc sestamibi, mibi, cardiolite, miraluma
    1. Lyophilized and in a nitrogen atmosphere
    2. 25 to 125 mCi of ^99mTc0₄^- is added in 1 - 3 mCi
    3. Mix well to assure that all the lyophilized material is in solution
    4. Boil for 10 minutes and let cool for 15
    5. Stable for 6 hours and stored at room temperature
15. ^99mTc succimer, DMSA
    1. pH 2 - 3
    2. Lyophilized and in a nitrogen atmosphere
    3. Add 40 mCi of ^99mTc0₄^- in 1 - 6 mL
    4. Incubate for 10 minutes at room temperature
    5. Stable for 4 hours
16. ^99mTc sulfur colloid, SC
    1. Kit contains lyophilized mixture in a reaction vial with 2 additional syringes (A and B)
    2. Compounding
       1. Add >300 mCi in a 1 - 3 mL is added to the reaction vial which contains
          1. Sodium thyiosulfate (active ingredient)
          2. Disodium edetate (Al chelator)
          3. Gelatin
       2. Syringe A contains HCl which acidifies the reaction prior to boiling
       3. Prior to boiling make sure that the reaction vial is negatively pressured
       4. Reaction vial is then boiled for 5 minutes
          1. Acidified thyiosulfate hydrolyzes and releases sulfur
          2. Sulfur then aggregates to create sulfur colloid particles
          3. The gelatin coats the particles causing a a negative charge (to repel each other ) and helps to control particle size
          4. Edetate removes any Al⁺³ and prevents flocculation [remember this]
       5. Syringe B contains anhydrous sodium biphosphate and sodium hydroxide that act as buffers which is added after the boil
17. ^99mTc tetrofosmin, Myoview
    1. Lyophilized and in a nitrogen atmosphere
    2. Kit is stored 2 - 8^oC
    3. As much as 240 mCi can be used in a 4 - 8 mL solution
    4. Remove 2 mL of gas and let incubate for 15 minutes
    5. Stable for 8 hours and kept at 2 - 25^oC

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